Pre-Arrangement Form

Pre-Arrange Online Now

Once you have completed this form click "Finish" at the bottom right, Lownes Funeral Home will contact you to schedule a convenient time to sit down with a Licensed Funeral Director to assist you with the many funeral service options available.

YOUR CONTACT INFORMATION

Full Name*:

Address

Address*:

City*:

Country*:

State/Province*:

Zip/Postal code*:

Cell Phone:

Home Phone*:

Email Address:

PRE-PLANNING PERSONAL INFORMATION

Name of person you are pre-planning for*:

Relationship to the person you are planning for*:

Birthplace:

Date of Birth:

Gender:

Marital Status:

Spouse's Name:

Include Maiden Name

Father's Name:

Mother's Name:

Include Maiden Name

Social Security Number:

Religious Preference:

Clubs and Affiliations:

EDUCATION

High School Name:

College Name:

Education 0-12 # of years:

College # of years:

Please list the name of all survivors, as well as their relationship, their spouse's name, the city they live in, and any other information that would be relevant for the memorial.